What are other surgical techniques used for the management of digital mucous cysts (DMCs)?

Updated: Jul 31, 2018
  • Author: Murad Alam, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Curettage of the cyst may be attempted, and this may or may not be combined with electrodesiccation. Caution should be exercised to reduce the risk of scar.

High-intensity light sources recently have demonstrated at least short-term success in the management of digital mucous cysts. Cysts have been vaporized with the carbon dioxide laser and treated with infrared contact coagulation. [17, 18]

Dermatologic and plastic surgeons have practiced cold-steel surgical excision of digital mucous cysts for several decades. This procedure ranges from simple excision of the cyst to wide, radical excision with possible graft [19] or flap reconstruction. Flaps used for reconstruction have historically been rotation flaps, [20] but rhomboid flaps [21] as well as advancement flaps [22] have been used safely and reliably and may be easier to apply in selected situations.

Another approach is marsupialization, or excision of the whole proximal nail fold, with subsequent healing by secondary intention.

In recent years, excision and debridement of joint osteophytes has been recognized as a necessary adjunct to reduce the risk of recurrence. Some hand surgeons believe that excision and debridement of the marginal osteophyte without removal of the cyst itself may be the best intervention. This results in less postoperative impairment in joint motion and fewer nail deformities since cyst dissection around the germinal matrix potentially may injure the underlying matrix and cause scarring. In general, more aggressive dissection leads to fewer recurrences and more nail deformities.

More recently, nail surgeons have attempted to treat recurrent or refractory cysts by repairing the causative leak of joint fluid in such lesions. [23] Methylene blue dye is first injected into the distal interphalangeal (DIP) joint. Then, a skin flap is raised around the cyst to find the area of dye-filled communication between the joint space and the cyst. This communication is then sutured shut and the flap is dropped back into place without tissue resection.


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